Bone and Joint Institute – Hip and Knee Joint Arthroplasty
When it comes to bone and joint conditions, no two patients are alike. Our specialists develop a specific treatment and rehabilitation plan that best meets each patient's needs.
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Hip and Knee Joint Arthroplasty Service
Penn State Bone and Joint Institute offers central Pennsylvania an unparalleled level of expertise in the treatment of arthritis of the hip and knee. All of our board certified surgeons have completed orthopaedic subspecialty fellowships in the area of joint arthroplasty. Our surgeons offer expertise in a range of pain relieving procedures including joint preservation surgery, hip resurfacing, partial knee replacement, total joint arthroplasty, and complex revision surgery. More than 1000 joint replacement procedures will be performed in state of the art operating rooms this year.
Avascular Necrosis (AVN), sometimes referred to as Aseptic Necrosis or Osteonecrosis, is an area of bone death resulting from poor blood supply to that bone. Dead areas of bone do not function normally, can eventually become weakened and collapse. The femoral head of the hip joint is a bone known to be prone to AVN.
Causes of AVN include trauma to the hip with subsequent damage to the blood vessels that supply the bone oxygen. Blockage of a bone’s blood supply by air or fat, abnormal blood vessel inflammation or unusually thick blood, are other known causes of AVN.
A variety of conditions are associated with AVN. Among these are alcoholism, corticosteroid medications, sickle cell anemia, Lupus, and radiation exposure.
AVN of the hip initially starts as a painless bone condition. Later, as the disease progresses and the bone weakens, pain develops, especially with weight bearing activities. Pain in the groin region can be felt with hip rotation when bone collapse progresses, eventually leading to pain at rest.
Diagnosis of AVN can be made from imaging studies. In the early phases of the disease, AVN may only be visualized by MRI. As the disease advances, changes become apparent on plain X-rays and signify a more advanced stage of the disease.
The treatment of AVN is highly dependent on the stage of the disease at the time of diagnosis. Early treatment may involve a procedure termed core decompression, where a core of bone from the involved area is drilled out and sometimes grafted with new bone. This is thought to allow a new blood supply to form with the goal of preserving the remaining bone. In later stages of the disease, significant changes to the bone and surrounding joint may require a joint replacement for treatment.
While most hip and knee replacements are very successful and last for a long time, occasionally a replacement fails sooner than we would like. Revising or re-doing a hip or knee replacement is done commonly, and the joint replacement surgeons at the Penn State Bone and Joint Institute have lots of experience with re-doing failed hip and knee replacements. Some of these revision surgeries are quite complicated while others are more straightforward depending on the patient’s particular circumstances. Fortunately most revision surgeries are able to make a big improvement in the patient’s life and can last for many years. If you have a hip or knee replacement that is giving you trouble, please give us a call to set up an appointment and we’d be happy to evaluate you and give you our thoughts.
Arthritis literally means inflammation of one or more joints. As one of the largest joints in the body, the hip is often involved. There are many types of hip arthritis, all of which involve some form of inflammation of the joint and associated damage and wear to the cartilage surfaces of the joint.
The most common types of arthritis include Osteoarthritis (related to wear and tear of the joint associated with activity and aging), Inflammatory arthritis (from an overactive immune system) and Post-traumatic arthritis (associated with a known significant previous trauma to the hip).
Symptoms of hip arthritis often include pain with motion and use of the joint and a limitation in joint functioning. Inflammation or swelling of the joint may also occur, but given the deep anatomic location of the hip is often difficult to appreciate, unlike an arthritic knee or hand.
Hip arthritis can affect anyone, men and women, adults and children.
Hip arthritis is diagnosed from a patient’s history and physical exam, x-rays, and sometimes blood or joint fluid tests. The pattern of symptoms, physical exam and x-ray findings (joint space narrowing, osteosclerosis, subchondral bone cysts, and bone spurs). Early and accurate diagnosis can be helpful to limit long term joint damage and disability.
The specific type of arthritis diagnosed is critical in guiding treatment. Treatments options can be numerous and may include physical therapy, anti-inflammatory medications, splinting or gait aides, immune altering medications and as an end stage treatment, surgery.
Infections rarely occur after knee replacement or hip replacement. When they do occur, they are typically treated by a team of doctors including an orthopaedic surgeon, an infectious disease specialist, and the patient’s medical doctor. Bacteria are capable of attaching to metal or plastic implants and antibiotics alone are not capable of curing an infection involving an implant. Cure requires surgical removal of the involved implant with placement of a temporary spacer or temporary implant. Most patients are placed on IV antibiotics for up to 6 weeks.
With the use of appropriate surgical management and a multi-disciplinary approach, most patients with joint related infections are successfully cured of their infection.
Arthritis means that the cartilage of a joint has begun breaking down over time. The loss of the smooth cartilage surface exposes bone and results in pain, stiffness, and deformity. Osteoarthritis, also known as degenerative joint disease (DJD), is the most common form of knee arthritis. It affects greater than 30% of people over the age of 60. Other, less common causes of knee arthritis include conditions such as gout, rheumatoid arthritis, psoriasis, or infection.
Osteoarthritis is a non-inflammatory condition that results from a combination of genetic predisposition and a person’s environment, such as work type or history of injury.
All current available treatments for osteoarthritis are aimed at improving a patient’s pain level. Medications are most effective when taken regularly. Injections may provide temporary pain relief with a good response measured in months. As the arthritis progresses, non-surgical options become less effective. Surgical options include Total Knee Arthroplasty (TKA) and Partial Knee Replacement. Surgery provides the most long-lasting improvements in pain relief and function.
From our Health Information Library
Partial Knee Replacement
Partial Knee Replacement or Uni-condylar Knee Arthroplasty (UKA) is a less invasive alternative to Total Knee Arthroplasty (TKA). The procedure preserves bone and reproduces more normal knee motion when compared to TKA. Faster recovery, lower risk of infection and fewer blood transfusions are other benefits. While TKA remains the gold standard treatment for severe knee arthritis, partial knee replacement can be an excellent option for select patients.
From our Health Information Library:
Total Hip Arthroplasty
Total hip replacement is also referred to as total hip arthroplasty. Total hip replacement is an excellent surgery for patients who have hip arthritis and reliably improves pain and typically lasts for a long time. Most patients who choose to have a hip replacement have had many non-operative treatments including Tylenol, anti-inflammatory medications Ibuprofen, Motrin, Advil, etc.) and/or a cane. When all of these treatments have failed and the patient has hip pain that markedly limits their ability to manage their home or participate in activities with their family, it is reasonable to consider a total hip arthroplasty (THA).
THA typically consists of removing the arthritic portion of the hip joint and replacing it with a metal and plastic hip joint. Most patients are in the hospital 2 or 3 days after hip replacement and use a walker or crutches for several days up to a few weeks after the surgery. Once the patient has recovered from the surgery they can walk, swim, bike, play golf and participate in most other low to moderate impact activities. We typically recommend that patients follow up yearly after hip replacement for the rest of their life.
If you are considering having a hip replacement or just interested in some more information about THA, please come by and see us and we would be happy to meet with you.
- Learn more about hip replacement in our Health Information Library
- View a slide show about total hip replacement
Penn State Bone and Joint Institute combines convenient services such as therapy, radiology, and prosthetics with our surgeon consultation areas. An integrated, multidisciplinary approach combines a team of dedicated physician assistants, orthopaedic nurses, anesthesia teams, and physical therapists to ensure a safe and appropriately brief hospital stay. Weekly joint replacement education classes prepare patients for their pre-operative, hospital, and rehabilitation experiences.
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Joint replacement education
Visit our Joint Replacement Education website to learn detailed information about hip or knee replacement surgery. The website contains a wealth of information for patients and their families at every stage of the joint replacement process. From things to consider before you decide to have surgery, to recommended joint strengthening exercise videos, to hospital stay information and what to expect in recovery, you’ll find it on the Joint Replacement Patient Education website.
Care Team – Hip and Knee Joint Arthroplasty
Frequently asked questions
Q: What is arthritis?
Arthritis is a wearing away of the lining (cartilage) between the ends of the bones in a joint. The cartilage is a smooth teflon-like surface that covers the ends of the bones. It acts as a shock absorber and allows the bones to move on each other in a smooth, painless manner. As the cartilage wears away the rough bone ends begin to rub on each other ("bone-on-bone") resulting in stiffness and pain.
Q: What causes arthritis?
There are a number of causes for arthritis. The most common type of arthritis is osteoarthritis which is often referred to as "wear and tear" arthritis. In most cases, it results from a lifetime of use of the joint for walking or other daily activities. It is not always clear why one person develops osteoarthritis and another does not or why only one hip or knee develops osteoarthritis. There can be a family or genetic link, especially in families where osteoarthritis at a young age is common.
A second relatively common from of arthritis is rheumatoid arthritis. This type results from an inflammation and swelling of the joint lining (synovium) which damages the joint surface. Patients with this type of arthritis are often cared for by a rheumatologist and an orthopedic surgeon in a team effort to control the inflammation and maintain joint function.
Prior injury to a joint may also predispose to early arthritis, especially if the joint is damaged in a fracture or break of the bone. This form of arthritis is termed post-traumatic arthritis and is often seen in younger patients.
Q: How is arthritis treated and what are the non-operative methods of treatment?
There are a number of treatment options for arthritis. The typical initial measures include activity modification, non-steroidal anti-inflammatory medications (NSAIDs), acetaminophen (Tylenol), gait aids (cane, crutch, walker) and weight loss.
Activity modification means avoiding activities which cause the joint to hurt. This may include limiting walking, lifting activities, overhead activities, stairs and squatting.
NSAIDs are medications intended to decrease inflammation and pain and soreness in a joint or muscle. They are best taken on a regular basis in those patients with chronic pain however may be taken intermittently if the pain is not always present. Stomach upset may be a significant problem with these medications.
Acetaminophen (Tylenol) can be very helpful in some patients with pain from arthritis used according to the label directions. Patients with liver problems should discuss this with a physician prior to use.
Gait aids can significantly relieve stress across the hip and knee and thus decrease pain. A cane or single crutch should generally be used in the hand opposite to the painful hip or knee.
Weight loss is extremely helpful in decreasing the pain of arthritis. Body weight is magnified up to seven times in passing through the hip or knee joint. Thus, even a small decrease in weight may result in a dramatic decrease in the forces across the hip or knee joint and less pain.
Q: Do I need an arthroscopy?
Arthroscopic surgery for osteoarthritis is most frequently performed at the knee, however, may occasionally be performed at the shoulder or elbow as well. It involves placing a small camera into the joint and using small instruments to remove loose pieces of cartilage. The results of this procedure are somewhat unpredictable, however it may be indicated in some patients with mild to moderate disease. This does not cure the arthritis, however it may significantly decrease the level of pain associated with the arthritis.
Q: Do I need an injection?
Several different types of injections are available for patients with osteoarthritis. The most common is an injection of corticosteroids possibly combined with an anaesthetic medication. This may provide significant pain relief for a substantial period of time in patients with mild to moderate arthritis, however it is somewhat unpredictable. Some patients do not have any improvement after the injection. The injection is generally performed as an office procedure and does not interfere with the ability to drive home. Injections can be repeated every several months for a total of up to three or four injections. This does not cure the arthritis, however it may decrease the level of pain.
More recently injections of synvisc or hyalgan have become more common. This is a viscous substance which is intended to decrease inflammation into the knee joint. The benefit of this substance has yet to be proven, however there is no evidence for significant complications related to its use.
Q: What is an osteotomy?
Some young , highly active patients with particular patterns of arthritis may be candidates for an osteotomy. This involves realigning the leg so that more of the weight is transmitted through the more normal parts of the joint. In many instances this may significantly decrease a patient's level of pain for a number of years. It is designed primarily for younger, highly active patients with relatively localized forms of arthritis.
Q: Who needs a joint replacement?
Joint replacements (joint arthroplasties) have been performed in the United States for approximately thirty years. Joint replacement involves removing the arthritic portions of the joint and replacing them with a plastic and metal artificial joint. It is generally available for hip, knee, shoulder, and elbow joints and is very effective for relieving pain at these joints. Range of motion is generally maintained with these joint replacements and most patients have an excellent functional result. Joint replacements are indicated in patients who have joint pain from arthritis which significantly interferes with their lifestyle and daily activities. It is generally recommended for older patients as there is a finite lifespan. At the hip and knee, an uncomplicated joint replacement has an approximately 85% chance of being intact and functioning after fifteen years. The overall results of joint replacement in properly selected patients are excellent and most patients have little or no pain after recovery from the surgery. The hospital stay is between four and six days with the full recovery between six weeks and three months. Following a hip or knee replacement, patients can drive, walk as far as they would like, ride an exercise bicycle, swim, play golf, dance, bike, and enjoy most other activities which do not involve repetitive jumping or twisting. Following your joint replacement, you should have x-rays at least every three to five years to be sure that the joint replacement is functioning properly.